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[Diagnosis] Recently diagnosed with severe sleep apnea (AHI=85.6)
#1
Recently diagnosed with severe sleep apnea (AHI=85.6)
Hey Gang,

I'm just beginning my apnea information journey as I was recently diagnosed with severe sleep apnea of 85.6 apnea events per hour. This was the result of a take-home sleep study. My doc said my results are in his top 3 of worst cases he's ever seen. He ordered an in-lab overnight study but my insurance has denied it. I will likely pay for it out-of-pocket but I want to get a jumpstart on my PAP therapy and would appreciate any advice I can get.

I believe my apnea may be hereditary as I'm generally fit (5'9" 175lbs. and don't smoke or drink). I suspect my dad has undiagnosed apnea as he has always been a heavy snorer and has high blood pressure as I do. I take meds for the high BP which my doc said is likely a result of the undiagnosed apnea. I always knew I snored, but my wife advised me that I seemed to be catching my breath in my sleep recently which prompted the initial home-study.

I just ordered the Resmed Airsense 10 with heated tube and the Phillips Respironics DreamWear full-face mask. I'm sure I'll have more questions along the way, but for starters I would love the group's feedback on the following:
  1. What kind of improvement can I realistically expect with the Airsense 10? In other words, how low can I expect to get my current AHI of 85.6?

  2. Will I likely notice improved sleep starting from day 1 of treatment or does it take several days/weeks/months?

  3. What do you notice as a result of your PAP therapy? More energy during the day/waking up less throughout the night/etc.?

  4. Is a sanitizing unit, like the Lumin UV, necessary or would daily/weekly cleaning with mild soap and water suffice?

  5. Is there a consensus on heated tube versus non-heated? I live in the southeast with very mild to no winters if that makes a difference.

  6. I am a side sleeper and mouth breather from what I can tell. Does anyone have any recommendations for other masks in case the Dreamwear doesn't work out?
Thanks in advance for any guidance. I'd appreciate any other feedback anyone has as well. Thanks so much.
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#2
RE: Recently diagnosed with severe sleep apnea (AHI=85.6)
Great to have you! You will find a lot of helpful experts who will chime in I'm sure. They are very knowledgeable and helpful. 

From what I can offer, the Airsense 10 is the best you could have gotten. I also wear the same DreamWear mask. Its been very dependable.

Having an AHI that high will be able to be improved I'm sure once the team sees your uploaded charts. They will ask you to download Oscar which is 

a great tool for diagnosing events. You'll just insert the memory card from your PAP machine into your PC and upload the data to Oscar. You'll find all 

the links on the Main page. Since I have begun therapy, I have had the best sleep I've ever had! I have moderate apnea. Getting used to the device 

was not a big deal for me knowing I'd be getting much better sleep. I surprised myself!

Good luck to you!
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#3
RE: Recently diagnosed with severe sleep apnea (AHI=85.6)
trialNerror,

The polusomnography lab sleep studies are expensive, that's a big out-of-pocket expenditure.

With the Airsense, you should see an immediate difference. You do need to adjust and acclimatize to the therapy air pressure and the mask. That might be very easy or it might take a while...  Seeing the machine data in Oscar will be an excellent place to start adjusting your treatment. I would recommend also getting a recording pulse-oximeter, a ring or a wrist watch type. (The ResMed integrated pulse-ox is very nice, but it costs about as much as the PAP machine.)

Next, the issue of positional obstructive breathing is something to determine. Head position and chin-tucking might be a problem for you. There are threads about using soft foam cervical collars to prevent chin-tucking.

Yes, you may see improvements immediately, probably so.

Probable the first thing you will notice is that your wife will sleep much better. And you will sleep better...  You will probably have reduced hypertension.

A sanitizing unit is not necessary.

The heated tube reduces or eliminates condensation of water in the tube. If you don't need the tube heating, it can be turned off.

There are threads about masks. I am/was a side sleeper and a mouth breather. I struggled with nasal masks and mouth leaks. I've used a full face mask for about five years, but I've just determined that the full face mask was probably detrimental to my treatment, and I have switched back to a nasal cannula and chin strap or mouth tape, and improved treatment. You will need to observe carefully how the masks are working for you.

I hope that helps. You have a positive attitude about the treatment and that is most important. Taking interest in the treatment and self-directing it will give you the best results possible. Also, it sounds like you have a good, cooperative relationship with your doctor. That is very important. (Unfortunately, there are reasons why PAP therapy turns into an adversarial conflict between patients, doctors, and insurance companies.)

Good Luck! You will get good results.

ETA: You showed the pressure settings of your machine as 4cm to 20cm. The machine has an exhalation pressure relief function, that reduces the pressure when you exhale. That improves comfort and improves ventilation, i.e. respiratory tidal volume. The setting can go from off (0) to 1cm, 2cm or 3cm pressure relief. The machine can go no lower than 4cm pressure, so your minimum pressure setting should be 4 *plus* your EPR number to get the full EPR benefit. E.g. I use an EPR of 3, so I would set the minimum pressure to 7cm, to get the ventilatory EPR effect.
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